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2013: Year in Review

The top story in health care for 2013 in Southeast Michigan continued to be how the Patient Protection and Affordable Care Act has altered the competitive landscape for hospitals, health insurers, physicians, clinics and other health care companies.

Changes brought about by Obamacare led to the takeover ofDetroit Medical Center by for-profit Tenet Health Care Corp. in June. In 2012, the health care reform bill — primarily because thousands of formerly uninsured patients will become paying patients — prompted the initial acquisition of DMC by for-profit Vanguard Health Systems.

But the two powerhouses soon found the combination unworkable because they have different management philosophies, and physician opposition proved too strong. Merger talks ended in May.

By October, however, hospital consolidation was back in the spotlight as McLaren Health Care Corp., an aggressive nonprofit health system based in Flint, took steps to acquire Karmanos Cancer Institute.

After nearly a year of debate, the majority of Michigan Republican legislators in September listened to key business leaders and signed on to the plan promoted by Gov. Rick Snyder, Democrats and the health care industry to expand Medicaid to 133 percent of the federal poverty level.

Starting next March, individuals with $15,500 or less annual income or a family of three with $26,500 or less will be able to seek coverage under Obamacare. Some 475,000 uninsured people are expected to become eligible.

But Republican opposition to Obamacare did not extend to approving a bill, also supported by Snyder, to create a state-based health insurance marketplace to sell private policies subsidized by the federal government.

Thirty-six other states also declined to set up their own state-based exchanges, essentially turning over those duties to the federal government.

And it was clear starting Oct. 1 and for the next four to six weeks that healthcare.gov was not up to the task of enrolling the majority of an estimated 16 million people with private policies and another 16 million in Medicaid.

News reports documented thousands of people who were upset that their current policies would be terminated Dec. 31 and told to choose new policies, many times at higher premiums.

Many people eligible for federal subsidies also were stymied in their efforts to purchase a private policy or enroll in Medicaid because of technical glitches with the website.

Finally, in early December, federal data showed that nearly 30,000 people were able to sign up for private insurance in a two-day period, exceeding the total of October. So far, nearly 300,000 people have signed up for a private policy or enrolled in Medicaid.

Other top stories in 2013 included:

Gov. Rick Snyder in February signed legislation making Blue Cross Blue Shield of Michigan a mutual insurance company. The nonprofit company had been the state’s designated insurer of last resort, a title no longer needed under health care reform. All health insurers are required to accept customers regardless of pre-existing medical conditions.

McLaren in June sued the state Department of Community Health over the denial of a certificate-of-need application to transfer 200 inpatient beds from its hospital in Pontiac to a hospital it wants to build in Clarkston.